Pacific Adhesives Company: Place an Order

Products

Place an Order

How to Place an Order

By Phone	Call 800.352.0012
By Fax	Fax your order to 916.383.0599
Online	Existing customers can order online by completing the order form below.

Customer Order Form

Note: You must be an existing customer of Pacific Adhesives company to use this form. If you are not a current customer, please contact us and we would be happy to open an account for you. Online orders are checked daily.

Fields marked with * are required.

Customer #:	(This can be found on the top right corner of your Invoice)
Name*:
E-mail*:
Phone*:	Ext:
Fax:
Bill To Address:
Company*:
Address*:
Address:
City*:	State: Zip:
Ship To Address: (if different than bill to)
Company:
Attn:
Address:
Address:
City:	State: Zip:

PO Number:
Ship Via:
Delivery Date:

Order Items:
1. Qty*: Unit*: Product*:

2. Qty: Unit: Product:

3. Qty: Unit: Product:

4. Qty: Unit: Product:

Comments or Special Instructions:

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